Epistaxis

Overview

• Definition: Bleeding from the nostril, nasal cavity, or nasopharynx.
• Commonly referred to as a nosebleed.
• Can be categorised into anterior and posterior bleeds.

Etiology

• Anterior epistaxis (most common):
  • Originates from the Kiesselbach’s plexus on the anterior part of the nasal septum.
  • Common causes: dry air, nose picking, minor trauma, colds, allergies.
• Posterior epistaxis:
  • Originates from branches of the sphenopalatine artery in the posterior part of the nasal cavity.
  • More likely in older adults.
  • Can be associated with hypertension, atherosclerosis, or trauma.
• Other causes: coagulopathy, anticoagulants, antiplatelets, inherited bleeding disorders, neoplasms, inflammatory conditions, etc.

Clinical Features

• Bleeding from one or both nostrils.
• Possibility of swallowing blood, leading to haematemesis or melena.
• Anxiety in the patient, especially if the bleeding is heavy or persistent.

Management

• Stay calm and reassure the patient.
• Have the patient sit up and lean slightly forward.
• Pinch the soft parts of the nose together, just below the bony part.
• For anterior bleeds, use of topical vasoconstrictors (e.g., oxymetazoline) or silver nitrate cauterisation if identified bleeding point.
• For persistent or posterior bleeds: nasal packing, consider admission and/or otolaryngology (ENT) consultation.
• Correct any coagulopathy or stop offending medications if safe and after discussing with relevant specialists.

Prevention

• Saline nasal sprays or lubricants in dry climates.
• Avoid nose picking.
• Control hypertension.
• Consider use of humidifier in dry environments.

Key Points

• Most epistaxis episodes are self-limiting and from anterior sources.
• Management involves pressure, topical treatments, and possibly packing.
• Seek underlying causes, especially if recurrent or significant.